Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review

There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis

ObjectivesTo understand and assess the degree of personalisation of tailored activities for people with dementia (PWD); and to estimate the magnitude of the effects of levels of personalisation on reducing behavioural and psychological symptoms of dementia (BPSD), improving quality of life (QoL) and level of engagement.DesignSystematic review with meta-analysis.Data sourcesProQuest, PubMed, Ovid, Cochrane Library, Web of Science and CINAHL were searched from the start of indexing to May 2020.Eligibility criteriaWe included randomised controlled trials and quasi-experimental studies assessing the effects of tailored activities for people aged 60 years or older with dementia or cognitive impairment on the outcomes of BPSD, QoL, depression and level of engagement with control groups.Data extraction and synthesisTwo researchers screened studies, extracted data and assessed risks of bias. A rating scheme to assess the degree of personalisation of tailored activities was developed to classify tailored activities into high/medium/low groups. Effect sizes were expressed using standardised mean differences at 95% Confidence Interval (CI). Subgroup analyses were conducted to assess whether the degree of personalisation of tailored activities affected outcomes of interest.ResultsThirty-five studies covering 2390 participants from 16 countries/regions were identified. Studies with a high-level of personalisation interventions (n=8) had a significant and moderate effect on reducing BPSD (standardised mean differences, SMD=−0.52, p<0.05), followed by medium (n=6; SMD=−0.38, p=0.071) and low-level personalisation interventions (n=6; SMD=−0.15, p=0.076). Tailored activities with a high-level of personalisation had a moderate effect size on improving QoL (n=5; SMD=0.52, p<0.05), followed by a medium level (n=3; SMD=0.41, p<0.05) of personalisation.ConclusionsTo develop high-level tailored activities to reduce BPSD and improve QoL among PWD, we recommend applying comprehensive assessments to identify and address two or more PWD characteristics in designed tailored activities and allow modification of interventions to respond to changing PWD needs/circumstances.PROSPERO registration numberCRD42020168556.

Exploration of non-pharmalogical interventions in the management of behavioural and psychological symptoms of dementia

Introduction: Behavioural and Psychological Symptoms of Dementia (BPSD) are considered as integral parts of dementia. Whilst pharmacotherapy is reserved for severe symptoms of BPSD, the associated adverse effects can be detrimental. Therefore, non-pharmacological intervention is recommended to be the frontline in the management of BPSD. This study aimed to explore the non-pharmacological approaches for the management of BPSD including the strategies and barriers of implementing them in secondary care facilities in Malaysia. Methods: A qualitative study design was employed. Data were collected through observations and semi-structured interviews of twelve caregivers and eleven people with dementia (PWD) at seven secondary care facilities. Observations were written in the field notes and interviews were audio-recorded and transcribed. All data were subjected to thematic analysis. Results: Some personalised non-pharmacological interventions such as physical exercise, music therapy, reminiscence therapy, and pet therapy were conducted in several nursing care centres. Collaborative care between care providers and family members was found to be an important facilitating factor. Hence, lack of family support led to additional workload, which were beyond the job scope of the care providers. Other barriers identified for non-pharmacological interventions were cultural and language differences between care providers and PWD, inadequate staff numbers and training, as well as time constraints. Conclusion: Although non-pharmacological approaches have been conducted to some extent in Malaysia, continuous education and training for the healthcare providers as well as the family members of PWD are needed to overcome the challenges with regards to their successful implementation.